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Experimental Evaluation of Thiazides and Potassium as a Cause of Small-Bowel Ulcer

Scott J. Boley, MD; Leon Schultz, MD; Harvey Krieger, MD; Solomon Schwartz, MD; Alberto Elguezabal, MD; Arthur C. Allen, MD
JAMA. 1965;192(9):763-768. doi:10.1001/jama.1965.03080220027006.
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Recent recognition of a sudden and startling increase in the incidence of small-bowel ulcerations has generated an intensive search for the cause of this phenomenon. Although some cases of perforation have been reported, the majority of patients have had signs of intestinal obstruction due to a short area of stenosis at the site of a circumferential ulcer. Three observations have been made which may be pertinent to the etiology and rising frequency of these lesions:

  1. In the majority of our patients we have noted microscopic abnormalities in veins and arteries beneath the small-bowel ulcers, and in the mesentery adjacent to them.1

  2. The presence of some underlying cardiovascular condition has been recognized in most, but not all, of the cases reported.2

  3. Lindholmer et al,3 and Baker et al4 suggested that enteric-coated thiazides with potassium, especially the latter, were the responsible agents and subsequent reviews


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